Venous Excess Doppler Ultrasound: A Visual Guide to Decongestion in Cardiorenal Syndrome
Promptly recognizing congestion, both clinical and hemodynamic, is paramount in the management of patients with heart failure. The pathophysiology of congestion involves a complex interplay of absolute fluid gain, volume redistribution from venous capacitance beds to the central venous circulation,...
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| Format: | Article |
| Language: | English |
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Karger Publishers
2023-10-01
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| Series: | Case Reports in Nephrology and Dialysis |
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| Online Access: | https://beta.karger.com/Article/FullText/531709 |
| _version_ | 1797641348444061696 |
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| author | Sirisha Gudlawar Abhilash Koratala |
| author_facet | Sirisha Gudlawar Abhilash Koratala |
| author_sort | Sirisha Gudlawar |
| collection | DOAJ |
| description | Promptly recognizing congestion, both clinical and hemodynamic, is paramount in the management of patients with heart failure. The pathophysiology of congestion involves a complex interplay of absolute fluid gain, volume redistribution from venous capacitance beds to the central venous circulation, inadequate excretion due to renal dysfunction, salt and water retention, and endothelial dysfunction. While congestive nephropathy is gaining wider recognition as a distinct variant of hemodynamic acute kidney injury (AKI), there are limited bedside diagnostic tools for proper evaluation of these patients. In this manuscript, we describe a case of AKI where POCUS helped us diagnose clinically silent congestion as well as monitor the response to therapy. A patient with heart failure with mildly reduced ejection fraction was initially administered intravenous fluids for rise in serum creatinine attributed to volume depletion. However, POCUS demonstrated a completely different scenario with severe venous congestion. Both sonographic stigmata of congestion and serum creatinine improved with diuretic therapy. Furthermore, serial venous excess Doppler ultrasound scans facilitated the visualization of decongestion in real time. |
| first_indexed | 2024-03-11T13:44:20Z |
| format | Article |
| id | doaj.art-884d4b28384e4161bd53eacbc01a3eaf |
| institution | Directory Open Access Journal |
| issn | 2296-9705 |
| language | English |
| last_indexed | 2024-03-11T13:44:20Z |
| publishDate | 2023-10-01 |
| publisher | Karger Publishers |
| record_format | Article |
| series | Case Reports in Nephrology and Dialysis |
| spelling | doaj.art-884d4b28384e4161bd53eacbc01a3eaf2023-11-02T10:50:46ZengKarger PublishersCase Reports in Nephrology and Dialysis2296-97052023-10-0113115616110.1159/000531709531709Venous Excess Doppler Ultrasound: A Visual Guide to Decongestion in Cardiorenal SyndromeSirisha Gudlawar0Abhilash Koratala1Division of Nephrology, Medical College of Wisconsin, Milwaukee, WI, USADivision of Nephrology, Medical College of Wisconsin, Milwaukee, WI, USAPromptly recognizing congestion, both clinical and hemodynamic, is paramount in the management of patients with heart failure. The pathophysiology of congestion involves a complex interplay of absolute fluid gain, volume redistribution from venous capacitance beds to the central venous circulation, inadequate excretion due to renal dysfunction, salt and water retention, and endothelial dysfunction. While congestive nephropathy is gaining wider recognition as a distinct variant of hemodynamic acute kidney injury (AKI), there are limited bedside diagnostic tools for proper evaluation of these patients. In this manuscript, we describe a case of AKI where POCUS helped us diagnose clinically silent congestion as well as monitor the response to therapy. A patient with heart failure with mildly reduced ejection fraction was initially administered intravenous fluids for rise in serum creatinine attributed to volume depletion. However, POCUS demonstrated a completely different scenario with severe venous congestion. Both sonographic stigmata of congestion and serum creatinine improved with diuretic therapy. Furthermore, serial venous excess Doppler ultrasound scans facilitated the visualization of decongestion in real time.https://beta.karger.com/Article/FullText/531709point-of-care ultrasoundvenous excess doppler ultrasoundcardiorenal syndromenephrology |
| spellingShingle | Sirisha Gudlawar Abhilash Koratala Venous Excess Doppler Ultrasound: A Visual Guide to Decongestion in Cardiorenal Syndrome Case Reports in Nephrology and Dialysis point-of-care ultrasound venous excess doppler ultrasound cardiorenal syndrome nephrology |
| title | Venous Excess Doppler Ultrasound: A Visual Guide to Decongestion in Cardiorenal Syndrome |
| title_full | Venous Excess Doppler Ultrasound: A Visual Guide to Decongestion in Cardiorenal Syndrome |
| title_fullStr | Venous Excess Doppler Ultrasound: A Visual Guide to Decongestion in Cardiorenal Syndrome |
| title_full_unstemmed | Venous Excess Doppler Ultrasound: A Visual Guide to Decongestion in Cardiorenal Syndrome |
| title_short | Venous Excess Doppler Ultrasound: A Visual Guide to Decongestion in Cardiorenal Syndrome |
| title_sort | venous excess doppler ultrasound a visual guide to decongestion in cardiorenal syndrome |
| topic | point-of-care ultrasound venous excess doppler ultrasound cardiorenal syndrome nephrology |
| url | https://beta.karger.com/Article/FullText/531709 |
| work_keys_str_mv | AT sirishagudlawar venousexcessdopplerultrasoundavisualguidetodecongestionincardiorenalsyndrome AT abhilashkoratala venousexcessdopplerultrasoundavisualguidetodecongestionincardiorenalsyndrome |